Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Wednesday, November 09, 2011

Just Five Little Minutes

"I estimate these changes to your charting work flow will take only five minutes."

Five minutes is fine if it happens for only one patient. But when it is multiplied by as many as forty patients in a day, the multiples get impressive. Five minutes x forty patients = 200 minutes (more than 1.5 hours a day).

Minor five-minute changes to administrative charting requirements aren't so minor, especially when you add more time for quality assurance reporting or pay-for-performance initiatives. Suddenly huge swaths of time from a doctor's opportunity to take care of their patients. We need more care time and less data entry time. Doctors must insist that we not become data entry clerks.

Increasingly, I see the data entry burdens of regulatory health care documentation requirements falling on doctors. On first blush, this seems logical because only doctors (or very capable, highly trained surrogates) understand the nuances required to make potentially life-altering adjustments to the electronic medical record. But when new administrative documentation requirements are added to doctors and other care providers, it compromises our time with patients where we explain the mechanisms of their disease and its management nuances. Discussions of medications, therapies, and required follow-up get get short shrift to mandated governmental documentation burdens. If we want to maintain patient volumes to improve access for new patients, we must get creative. After all, time is not expandable.

And there could be a better way.

I believe we need to get patients more involved in their own care before they see their doctor. Imagine a patient entering proposed changes to their list of health problems, surgeries performed, medications and doses being taken and allergies before they are seen on their cell phone or local waiting-room computer terminal or iPad. These proposed changes could then be reviewed, validated, a approved (or not) by their doctor leaving the majority of the patient visit for what matters: actual patient care.

Then maybe, just maybe, I could salvage four of those five precious minutes for both of us.

My daughter's rheumatologist now only sees five patients in a morning instead of ten. Her employer reduced patient load to give the doctors time to do the computer work. Seems to me it would make more sense to see more patients and pay somebody to do the data entry.

Dennis said... "I think I would change jobs... "And who, pray tell, would do the data entry... I mean patient care then. The system can't do without physicians. Who would take all the liability?I can imagine a large chart on the clinic wall with all the physician's pictures. The chart reads, "You won't see any of the doctors, today, but who would you like to take liability for you this time? Just check the box by the picture."

Dennis also said, "No[t] much more than a cattle call at the slaugter house. "Damn us doctors for roaming the streets and dragging all those patients into the office! Why couldn't we just wait for them to call and make an appointment (that they expect to get ASAP) for that medical problem they have. Damn us for taking every day off but one and cramming all 40 patients into that one day! Why can't we just drop to ten patients a day, 4 days a week? Then the next appointment Dennis could get would be in about... say... 4 months!!

WarmSocks said... "Seems to me it would make more sense to see more patients and pay somebody to do the data entry." Perhaps doctors should just take the job of data entry technicians. I doubt they would face the continuously decreasing re-imbursement they do as physicians!I think all those folks disgruntled with physicians should just quit getting medical care! Better do it quick, though. Somewhere down in the bowels of Obamacare there may be a mandate that you get medical care!

Something is crazy. Start with the 200 minutes thingy. Are you seeing 40 patients a day and working 12 hour days? No breaks? No lunch? THAT'S crazy. Besides needing to see a doc who will counsel you on some lifestyle changes, looks like you're in need of a good union rep!

And before we get another lecture from Dr. Hulsey.....do need more med schools? I wonder how many there were in 1980 and how many there are now. Have they kept up with the growth in population and aging?

I USED to :o) --no longer there. I saw 30-60 patients/day depending on who was covering. Full documentation: Med rec., Hx past current, lab/test review, CC - quicky exam and then more focused. Send MD in with my pelim thoughts, I may or may not go back in. Then there was phone triage @15-20 calls/day... hard to get to. No time built in schedule for that. And a totally sucky EMR.

Anonymnous #1 said, "And before we get another lecture from Dr. Hulsey..... Do we need more medical schools?"I'm glad you're paying attention. I hate to lecture when people are napping! Of course we need more medical schools. We doctors out here seeing patients don't make those decisions, however. In the last 40 years the estimate of doctor population adequacy has vacillated 180 degrees. First, we're short. Then, we're producing plenty. I think it's pretty clear there aren't enough "providers" of any type to carry the demand. With the cost of ANY type of education at current rates and the decreasing re-imbursement rates to providers, we aren't likely to EVER have enough!SCRN asked, "Who does the documentation..."I do all the documentation in my office. I dictate all my notes which are transcribed by MacSpeech Medical Dictate. I do all letters for pre-authorization and letters to referring physicians and nurse practitioners. In my 37 years as a physician, I have worked more 12, 14, 16, or 24 hour days than I can count. I've never had someone who wrote progress notes for me or dictated hospital documents. I have NEVER used an EMR in my office. They are all"sucky" IMHO. I waste more time going through a referral note generated from doctors with EMR to get to what's important than I do from everything except all those "just one signatures" for the hospital! EMRs are the devil's spawn for medical care, as are people with MPH degrees!

The last thing I meant in my post was to denigrate the doctors. Of course we need them (as do doctors need doctors) and we need auto mechanics and truck drivers and all manner of folks who keep our society running but what we do not need is more data mining. I am not talking about records, I am talking about the extra data that sucks us all dry. We a reproducing ourselves out of a planet and any hope of quality care in the coming decades. We are looking at a quantum leap that will result in a new man and woman that can get the time in front of a doctor or medical facility and money and power will be the key as the rest fall by the wayside and are left out... No money no honey as the girls in WestPac used to say.

Dennis said, "No money no honey as the girls in WestPac used to say."God bless you for your WestPac service, and I hope a little honey came your way! I understand your cattle call analogy, and at times it is, but that is dictated by demand for the individual physicians time.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.